Department of Hematology, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris 13, Bobigny, France.
Department of Biostatistics, St Louis Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris 7, Paris, France.
Cancer. 2015 Jul 15;121(14):2393-9. doi: 10.1002/cncr.29389. Epub 2015 Apr 6.
Reports of patients with secondary acute promyelocytic leukemia (APL) have increased in recent years, particularly for those who received treatment with mitoxantrone, and retrospective studies have suggested that their characteristics and outcomes were similar to those of patients with de novo APL.
The authors investigated patients with de novo and secondary APL who were included in the ongoing APL-2006 trial. Patients with secondary APL who were included in that trial also were compared with a previous retrospective cohort of patients with secondary APL.
In the APL-2006 trial, 42 of 280 patients (15%) had secondary APL. Compared with the retrospective cohort, patients with secondary APL in the APL-2006 trial had a lower incidence of prior breast carcinoma (35.7% vs 57%; P = .03) and a higher incidence of prior prostate carcinoma (26.2% vs 4.7%; P < .001). Treatment of the primary tumor in the APL-2006 trial less frequently included combined radiochemotherapy (28.6% vs 47.2%; P = .044) and no mitoxantrone (0% vs 46.7%; P = .016) but more frequently included anthracyclines (53.3% vs 38.3%; P = .015). In the APL-2006 trial, patients who had secondary APL, compared with those who had de novo APL, were older (mean, 60.2 years vs 48.7 years, respectively; P < .0001) but had a similar complete response rate (97.6% vs 90.3%, respectively), cumulative incidence of relapse (0% vs 1.8%, respectively), and overall survival (92.3% vs 90.9%, respectively) at 18 months.
Although the incidence of secondary APL appears to be stable over time, evolving strategies for the treatment of primary cancers have reduced its occurrence among breast cancer patients but have increased its incidence among patients with prostate cancer. The current results confirm prospectively that patients with secondary APL have characteristics and outcomes similar to those of patients with de novo APL.
近年来，继发性急性早幼粒细胞白血病（APL）患者的报告有所增加，尤其是那些接受米托蒽醌治疗的患者，回顾性研究表明，他们的特征和结局与新发 APL 患者相似。
作者研究了纳入正在进行的 APL-2006 试验的新发和继发性 APL 患者。该试验中纳入的继发性 APL 患者也与之前的继发性 APL 回顾性队列进行了比较。
在 APL-2006 试验中，280 例患者中有 42 例（15%）患有继发性 APL。与回顾性队列相比，APL-2006 试验中的继发性 APL 患者中既往乳腺癌的发病率较低（35.7%比 57%；P=.03），既往前列腺癌的发病率较高（26.2%比 4.7%；P<.001）。APL-2006 试验中，原发性肿瘤的治疗较少采用联合放化疗（28.6%比 47.2%；P=.044）和米托蒽醌（0%比 46.7%；P=.016），但更多采用蒽环类药物（53.3%比 38.3%；P=.015）。在 APL-2006 试验中，与新发 APL 患者相比，患有继发性 APL 的患者年龄较大（分别为 60.2 岁和 48.7 岁，P<.0001），但完全缓解率相似（分别为 97.6%和 90.3%），复发累积发生率（分别为 0%和 1.8%）和 18 个月时的总生存率（分别为 92.3%和 90.9%）相似。
尽管继发性 APL 的发病率似乎随着时间的推移而稳定，但治疗原发性癌症的策略不断发展，减少了乳腺癌患者中继发性 APL 的发生，但增加了前列腺癌患者中继发性 APL 的发生。目前的结果前瞻性地证实，继发性 APL 患者的特征和结局与新发 APL 患者相似。
